Omni Wellness Group LLC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

Legal business name

OMNI WELLNESS GROUP LLC

Practice address

1149 Experiment Farm Road
Troy, OH 45373

Phone

(937) 540-9920

Fax

(937) 202-0213

NPI assigned

May 18, 2018

Last updated

Oct 30, 2023By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Sheila Petrequin

Title

Billing Manager

Phone

(937) 438-9500

Specialties & licenses 2

Addresses

Other names 1

• Omni Wellness Group Former legal business name

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/25145/brand/1/csg/1/fhir/r4

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1526601600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1698624000000",
    "number": "1861982423",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1149 EXPERIMENT FARM RD",
            "city": "TROY",
            "state": "OH",
            "postal_code": "453731071",
            "telephone_number": "937-438-9500",
            "fax_number": "937-886-5694"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1149 EXPERIMENT FARM ROAD",
            "city": "TROY",
            "state": "OH",
            "postal_code": "45373",
            "telephone_number": "937-540-9920",
            "fax_number": "937-202-0213"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OMNI WELLNESS GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-05-18",
        "last_updated": "2023-10-30",
        "certification_date": "2023-10-30",
        "status": "A",
        "authorized_official_last_name": "PETREQUIN",
        "authorized_official_first_name": "SHEILA",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "937-438-9500"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Omni Wellness Group",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Omni Wellness Group",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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• Psychiatric/Mental Health Nurse Practitioner in Troy, OH
• Providers in Troy, OH by specialty
• Psychiatric/Mental Health Nurse Practitioner in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.